BASIC FUNCTIONS:

The Medical Coder is responsible for the revenue cycle activities of specific physician practices of Ellis Medical Group (EMG). This includes but is not limited to (1) managing the charge entry and charge reconciliation process for the assigned practice(s), (2) managing the Encounter Billing Exception Worklist (EBEW) and related worklists to ensure complete, timely and accurate submission of claims, (3) facilitating the accuracy and completeness of the practice’s codes and charges in the Service Catalog (Charge Description Master) and related encounter forms, (4) ensuring compliance with CPT/HCPCS and ICD-9/ICD-10 coding guidelines and government regulations, responsible for reviewing and coding from discharge data abstracts; and (5) ensuring the practice(s) is optimizing reimbursement from third party payors by following and utilizing reimbursement guidelines. This position requires interacting with EMG leadership, healthcare practitioners, practice management and staff; (6) Establish relationships with medical/dental staff, follow-up with providers to ensure documentation supports the diagnoses and E/M level in question; (7) Responsible for weekly chart audits for practice providers to optimize accurate documentation and coding. Additionally, all Medical Coder will participate in regularly scheduled cross-functional workgroups to coordinate and improve revenue cycle activities within all EMG practices and across Ellis Medicine. This position has significant responsibility for ensuring the financial viability of the assigned practice(s), by producing claims in a timely, accurate and complete manner.

EDUCATION AND EXPERIENCE REQUIREMENTS:

Education: High School Diploma or Equivalent required.

Certification: Certified Professional Coder (CPC), Certified Coding Specialist (CCS),

Registered Health Information Technician (RHIT) or Registered Health

Information Administrator (RHIA) required. Additional specialty certification required.

Experience: Minimum of five years out patient coding experience required. Hospital,

physician practice or insurance coding and billing experience required. Working knowledge of healthcare revenue cycle functions, including coding and billing guidelines and government/payor regulations.

Other: Knowledge of Anatomy and Physiology, Medical Terminology and current coding standards. Skilled experience and knowledge of Windows based software required, including but not limited to Microsoft Windows, Excel and Word. Experience with Siemens Soarian systems and Allscripts electronic health record preferred.

MAKING ELLIS EXCEPTIONAL (MEE) BEHAVIORS & STANDARDS

RESPONSIBILITIES OF THE POSITION:

• Responsible for managing charge entry and charge reconciliation for the assigned physician practice(s).
• Responsible for reviewing Inpatient, Surgeries, and Practice records for diagnoses and procedures and assigns the appropriate ICD-9-CM and CPT-4 codes utilizing the Allscripts and the Soarian Financial Management Systems.
• Establish relationships with medical/dental staff, follow-up with providers to ensure documentation supports the diagnoses and E/M level in question. Responsible for weekly chart audits for practice providers to optimize accurate documentation and coding.
• Responsible for managing the Encounter Billing Exception Worklist (EBEW) and related worklists that hold claims from billing, establish and maintain a close working relationship with the PBO dept. to reduce and address claim issues and denials timely.
• Assists in the maintenance of the practice’s charges and coding, in cooperation with the Charge Description Master (CDM) Manager and Health Information Services (HIS) Department.
• Responsible for participation in on-going education relevant to practice specialty, assists in training for new employees and coverage.
• Works closely with the Practice Leader and the RCA Supervisor to ensure that all updates and changes are implemented timely.
• Maintains a high level of confidentiality to protect patient health information privacy, while providing access to authorized individuals and entities, and safeguards the integrity of electronic records.
• Will participate in standing cross-functional workgroups to facilitate resolution of systems issues and operational issues within Ellis Medical Group and across the enterprise (Ellis Medicine).
• Responds promptly to customer questions, provides excellent customer service and collaborates with other departments (PBO) throughout the organization.
• Medical Coder demonstrates knowledge of computer applications, specifically Soarian Financial Management, Soarian Scheduling, Soarian Clinicals (HIM Prod), and Allscripts.
• The Medical Coder performs other duties as assigned.
• Adheres to hospital and procedures related to mandatory education and annual health assessments, MEE Behavior and Standards, AIDET.